血清甲状腺激素水平与甲状腺"温"结节临床关系的初步观察

探讨血清甲状腺激素水平与核素99mTcO-4甲状腺显像为"温"结节的甲状腺肿块的病理分型的关系和对甲状腺结节样增生患者实施保守治疗的效果.观察了53例手术治疗的甲状腺"温"结节患者术前的甲状腺激素水平和术后的病理类型.病理结果显示,结节样增生、增生样囊性变与囊腺瘤、纤维样增生腺瘤、甲状腺滤泡状癌比较,前两种病例血清的TT3、TT4、FT3及FT4的水平明显低于后三种病例,而sTSH值却有所上升.根据上述结果,选择了65例甲状腺激素水平类似于甲状腺结节样增生的"温"结节患者,给予甲状腺片补充治疗.治疗后六个月后,B超检查有9例患者增生的肿块基本消失,其他患者的肿块均有不同程度的缩小,平均缩小率34.8%.TT3、TT4、FT3、FT4值均在正常值内有所提高.而sTSH值在正常值内有所降低(P＜0.01).治疗中患者均没有主诉发生不良反应.这提示"温"结节的患者血清TT3、TT4、FT3、FT4值在正常值范围低值,而sTSH值大于2.5mol/L以上时,替代治疗可能是一种较有价值的观察治疗方法.

Preliminary Observation of the Clinical Relation Between Serum Level of Thyroid Hormones and Warm Radionuclide Imaged Nodules

In order to observe the relation of serum level of thyroid hormones and pathological types of warm thyroid nodules imaged by~(99m)TcO~-4,and the possible effect of the non-operational therapy to the patients with thyroid nodular hyperplasia,53 patients with thyroidal warm imaged nodules had their serum hormones assayed before operation and the pathological types of nodules examined after operation.It has been shown that there were five pathological types(nodular hyperplasia,proliferative cystic degeneration,cystic adenoma,fibroid proliferative adenoma and follicular carcinoma) of nodules,and patients with two former types had their serum levels of TT3,TT4,FT3 and FT4 lowered than those of patients with the later three nodular types,but on the contrary,serum TSH concentration of two former nodular types was higher than that of later three types.Based on above result,65 patients of thyroid nodular hyperplasia with warm imaged nodules were treated with supplementation of thyroid tablet.After 6 month treatment,9 patients had their nodules disappeared basically under ultrasonic examination,and the nodules of the rest patients became smaller in different degree,with an average of 34.8% in size.Serum TT3,TT4,FT3 and FT4 were raised to some extent in the normal range,while serum TSH was lowered within the normal range.No side effect was complained.The above result suggest that for patients with thyroid warm imaged nodules with their serum TT3,TT4,FT3 and FT4 in lower normal range and serum TSH value higher than 2.5 mol/L,substitutive therapy might be a valuable way to follow.